HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 631 Optometry
SPONSOR(S): Professions & Public Health Subcommittee, Rizo
TIED BILLS: IDEN./SIM. BILLS: SB 876
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 14 Y, 3 N, As CS Morris McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
Optometrists examine, diagnose, treat, and manage diseases and injuries of the visual system as well as
identify systemic conditions which affect visual health. Optometrists are regulated under ch. 463, F.S., by the
Board of Optometry (Board) within the Department of Health (DOH). Optometrists may prescribe certain ocular
medications listed in law or established in a formulary by the Board, but may not perform certain surgical
procedures using an instrument, including a laser, scalpel, or needle.
CS/HB 613 creates a new category for certification of licensed optometrists, “optometrist certified in ophthalmic
procedures,” which authorizes the performance of board-approved laser and non-laser ophthalmic procedures
and therapy.
The bill repeals the statutory formulary that specifies the oral ocular pharmaceutical agents a certified
optometrist may administer or prescribe, expanding the types of drugs certified optometrist may administer or
prescribe. Instead, the Board is required to create a negative formulary consisting of ocular pharmaceutical
agents that a certified optometrist may not administer or prescribe. The bill also repeals the requirement that
certified optometrists complete a board-approved course and examination in order to administer and prescribe
oral ocular pharmaceutical agents.
The bill prohibits a certified optometrist from administering or prescribing controlled substances for acute pain
for more than 72 hours. The bill prohibits a certified optometrist from administering or prescribing Schedule II
controlled substances except for oral analgesics for pain relief of the eye and its appendages. Current law
allows this exception for Schedule III, IV, and V controlled substances.
The bill authorizes certified optometrists to perform board authorized laser and non-laser ophthalmic
procedures and therapies.
The bill requires the Board to adopt rules relating to the performance of laser and non-laser ophthalmic
procedures and therapies, the scope of the practice of optometry, and the required content, grading criteria,
and passing scores for the optometry licensure examination.
The bill has an insignificant, negative fiscal impact to DOH which can be absorbed within current resources.
The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
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DATE: 3/24/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Optometrists and Ophthalmologists
Optometrists examine, diagnose, treat, and manage diseases and injuries of the visual system as well
as identify systemic conditions which affect visual health. Optometrists are regulated under ch. 463,
F.S., by the Board of Optometry (Board) within DOH. The Board is composed of seven members
appointed by the Governor and confirmed by the Senate. Five members must be licensed practitioners
actively participating in this state and the two reaming members must be citizens of the state that are
not and have never been licensed practitioners.1
Optometrist training involves an undergraduate degree and completion of a 4-year program at a college
of optometry. Some optometrists complete residencies to gain more specialized knowledge, but
residency training is not required for licensure or practice.2
Ophthalmologists are medical doctors who specialize in diseases of the eye. Ophthalmologists provide
a full spectrum of eye care, from prescribing corrective lenses and medications to performing eye
surgery. Ophthalmologists also care for patients with more advanced and complicated diseases than
optometrists. Ophthalmologists are regulated under ch. 458 and 459, F.S., by the Board of Medicine
and the Board of Osteopathic Medicine within DOH. Ophthalmologist training involves an
undergraduate degree, 4 years of medical school, and completion of at least 4 years of residency
training in ophthalmology.3
The American Council for Graduate Medical Education (ACGME)4 requires each opthamologist
resident to perform a minimum number of certain surgeries before he or she may graduate from the
program. Residents must perform the following minimum number of surgeries:5
Cataract 86
Laser Surgery- YAG Capsulotomy 5
Laser Surgery - Laser Trabeculoplasty 5
Laser Surgery – Laser Iridotomy 4
Laser Surgery – Panretinal Laser Photocoagulation 10
Keratoplasty 5
Pterygium/Conjunctival and other cornea 3
Keratorefractive Surgery 6
Strabismus 10
Glaucoma – Filtering/Shunting Procedures 5
Retinal Vitreous 10
Intravitreal Injection 10
Oculoplastic and orbit– Total 28
Oculoplastic and orbit – Eyelid Laceration 3
Oculoplastic and orbit – Chalazia Excision 3
Oculoplastic and orbit – Ptosis/Blepharoplasty 3
1 Section 463.003, F.S.
2 American Optometric Association, What is a Doctor of Optometry?, http://www.aoa.org/about-the-aoa/what-is-a-doctor-of-
optometry?sso=y (last visited March 17, 2021).
3 American Academy of Ophthalmology, What is an Ophthalmologist?, https://www.aao.org/eye-health/tips-prevention/what-is-
ophthalmologist (last visited March 17, 2021).
4 ACGME sets standards for and accredits US graduate medical education (residency and fellowship) programs. Available at:
http://www.acgme.org/What-We-Do/Overview (last visited March 17, 2021).
5 ACGME Review Committee for Ophthalmology, Frequently Asked Questions,
https://www.acgme.org/Portals/0/PDFs/FAQ/240_ophthalmology_FAQs.pdf (last visited March 17, 2021).
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Globe Trauma – Total 4
ACGME resident case logs between 2015 and 2016 showed that the average resident performed 183
cataract surgeries, 13.4 glaucoma surgeries, and 107.6 laser surgeries.
Florida law requires optometrists diagnosing a patient with certain diseases to refer such patients to
“physician skilled in the diseases of the eye” (ophthalmologists) for further treatment.6 Additionally, an
optometrist must promptly advise a patient to seek an evaluation by an ophthalmologist for diagnosis
and possible treatment whenever the optometrist is informed by the patient of the sudden onset of
spots or “floaters” with loss of all or part of the visual field.7 Optometrists must maintain the names of at
least three physicians, clinics, or hospitals to which they may refer patients who experience adverse
drug reactions.8
Five states, Alaska, Arkansas, Kentucky, Louisiana, and Oklahoma allow optometrists to perform
surgical procedures.9 Oklahoma has allowed optometrists to perform surgical procedures since 1988.10
Oklahoma requires passage of the Laser Therapy for the Anterior Segment Course offered by
Northeastern State University to become a licensed optometrist.11 The course consists of 9 hours of
lectures and 4 hours of laboratory sessions with hands-on training.12
Between 1988 and 1998, 5,000 laser surgeries were performed by optometrists in Oklahoma.13 A
review by the Oklahoma Board of Examiners in Optometry of the outcomes of those surgeries found
that negative outcome rates ranged between 0.5%-1.5% and were the same as those of surgeries
performed by ophthalmologists in Oklahoma.14 Since 1998, 25,000 anterior laser surgeries have been
performed by optometrists in Oklahoma and the Oklahoma Board of Examiners in Optometry has not
received any complaints regarding those surgeries.15
A 2016 peer-reviewed study that analyzed the outcomes for laser glaucoma surgeries between 2008
and 2013 in Oklahoma found that patients were nearly twice as likely to need additional treatment when
the procedure was performed by an optometrist as compared to an ophthalmologist.16 The study also
found there was a 189% increased risk of needing additional treatment in the eye that had been treated
when the procedure was performed by an optometrist as compared to an ophthalmologist.17
Laser Glaucoma Surgery Outcomes in Oklahoma18
6 Diagnoses which mandate a referral to an ophthalmologist include angle closure glaucoma, congenital or infantile glaucoma, and
infectious corneal diseases that are unresponsive to standard treatment. Section 463.0135, F.S.
7 Section 463.0135(4), F.S.
8 Section 463.0135(8), F.S.
9 National Conference of State Legislatures, Optometrist Scope of Practice, https://www.ncsl.org/research/health/optometrist-scope-of-
practice.aspx (last visited on March 17, 2021). In September 2020, the Arkansas Supreme Court ruled to disqualify Arkansas Issue 6,
the Practice of Optometry Referendum, from the 2020 general election ballot, allowing optometrists to continue to perform a range of
surgeries. See Arkansas Democrat Gazette, Ruling Keeps Question on Eye Surgery off State Ballot,
https://www.arkansasonline.com/news/2020/sep/18/ruling-keeps-question-on-eye-surgery-off-ballot/ (last visited March 17, 2021).
10 Testimony of Dr. April Jasper, former President of the Florida Optometric Association, on file with Professions and Public Health
Subcommittee staff.
11 Oklahoma Board of Examiners, Licensing, https://optometry.ok.gov/licensing.htm (last visited March 17, 2021).
12 Stein, J.D., et. al. Comparison of Outcomes of Laser Trabeculoplasty Performed by Optometrists vs. Ophthalmologists in Oklahoma.
JAMA Ophthalmol. 2016;134(10):1095-1101.
13 Supra, note 10.
14 Id.
15 Id.
16 Supra, note 12.
17 Id.
18 Id.
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Probability of 1 or more Probability of 1 or
Number of
Number of eyes that additional surgeries more additional
eyes that
Provider received 1 or more performed during 10 surgeries performed
received laser
additional surgeries days after initial 11-30 days after initial
surgery
surgery surgery
Ophthalmologist 1150 174 (15%) 0 1.1%
Optometrist 234 84 (35.9%) 0.4% 10.3%
Optometrist Prescribing Authority in Florida
Currently, Florida law allows licensed optometrists to administer and prescribe drugs under limited
circumstances. Licensed optometrists may only use topical anesthetics for glaucoma examinations,
unless the licensed optometrist is also a certified optometrist.19 Certified optometrists may administer
and prescribe topical or oral ocular pharmaceutical agents for the diagnosis and treatment of ocular
conditions of the human eye and its appendages without the use of surgery or other invasive
techniques.20
To be certified by the board to administer and prescribe topical ocular pharmaceuticals, a licensed
optometrist must be complete at least 110 hours of board approved coursework and training and one
year of supervised experience in differential diagnosis of eye diseases or disorders.21 Certified
optometrists that also wish to administer and prescribe oral ocular pharmaceutical agents must also
complete a board-approved 20-hour course and examination on general and ocular pharmaceutical
agents and their side effects.22 If a certified optometrist does not complete the course and examination,
he or she may only administer or prescribe topical ocular pharmaceutical agents as established by
board rule.23
The oral ocular pharmaceutical agents a certified optometrist may administer or prescribe are specified
in a statutory formulary.24 The agents include seven antibiotics and three antivirals:25
Amoxicillin with or without clavulanic acid;
Azithromycin;
Erythromycin;
Dicloxacillin;
Doxycycline/Tetracycline;
Keflex; and
Minocycline.
Acyclovir;
Famciclovir; and
Valacyclovir.
Current law prohibits a certified optometrist from administering or prescribing certain drugs for more
than 72 hours, including two analgesics and two anti-glaucoma agents:26
Tramadol hydrochloride; and
19 Section 453.0055(1)(a), F.S.; Chapter No. 2013-26,L.O.F.
20 Ss. 463.0055(1)(a) and 463.002(4), F.S.
21 Rule 64B13-10.001, F.A.C.
22 Section 463.0055, F.S.
23 Rule 64B13-18.002, F.A.C.
24 Section 463.0055(3), F.S.
25 Section 463.0055(3)(b), F.S.
26 Section 463.0055(3)(a), (c), (d) F.S.
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Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
Acetazolamide; and
Methazolamide.
Any oral ocular pharmaceutical agent listed in the statutory formulary which is subsequently determined
by the U.S. Food and Drug Administration to be unsafe for the administration or prescription is
considered to have been deleted from the statutory formulary.27
The statutory formulary prohibits the administration or prescription of a controlled substance listed in
Schedule III28, Schedule IV29, or Schedule V30 of s. 893.03, F.S., except for the oral analgesics
specified in the statutory formulary for the relief of pain due to ocular conditions of the eye and its
appendages, or a controlled substance for the treatment of chronic nonmalignant pain.31
As of February 2021, there are 3,855 licensed certified optometrists and 91 non-certified optometrists in
this state.32 Since July 1, 1993, graduates of accredited schools of optometry have been considered
certified optometrists as the curriculum changed to include specific training on administering and
prescribing ocular pharmaceutical agents.33 There are currently 51 optometrists in this state licensed
before July 1, 1993 that are not certified.34
Optometrist Scope of Practice in Florida
Optometrists may prescribe certain medications, vision therapy, and corrective lenses, but may not
perform surgical procedures in Florida.35 Florida law defines surgery as a procedure using an
instrument, including a laser, scalpel, or needle, in which human tissue is cut, burned, scraped, or
vaporized by incision, injection, ultrasound, laser, infusion, cryotherapy, or radiation and also includes a
procedure using an instrument which requires the closure of human tissue by suture, clamp, or a
similar device.36 However, certified optometrists that are authorized to administer or prescribe certain
medication, may perform the following optometric practices37:
Performing an eye examination, including a dilated examination, if required or authorized under
laws related to pugilistic exhibitions;38
Removing an eyelash by epilation;
Probing an uninflamed tear duct in a patient 18 years of age or older;
Blocking the puncta by plug;
Performing a superficial scraping to remove damaged epithelial tissue or superficial foreign
bodies or take a culture of the surface of the cornea or conjunctiva; and
Using commonly accepted means or methods to immediately address incidents of anaphylaxis.
Effect of Proposed Changes
27 Id.
28 Section 893.03(3), F.S. defines a Schedule II substance as a substance that has a potential for abuse less than the substances
contained in Schedu